Metastasizing pleomorphic adenoma

Case contributed by Dr Abbas M. Mahmood

Presentation

Right side mandibular swelling, History of recurrent submandibular gland pleomorphic adenoma and multiple operations.

Patient Data

Age: 25 years
Gender: Male

Right parotid gland: shows mildly enhancing nodule, measuring 19mm near the angle of the mandible, possibly pleomorphic adenoma.

Right submandibular gland is not seen (removed)

There are two expansile lesions involving the right mandibular body, one is measuring 5.6 cm near the symphysis menti, other measuring 2.0 cm near the angle of the mandible, both are showing soap bubble appearance with cortical destruction.

Given the possibility of metastases, a chest x-ray was performed. 

X-ray

A well-circumscribed nodule in the left upper zone.

Subsequently, a CT chest arranged for further characterize the lesions on the chest x-ray.

There are two well-defined lesions contain solid and few cystic components 

One is measuring 38x30 mm at the anterior segment of the left lobe and another 22x18 mm at the posterobasal segment of the left lower lobe, abutting the posterior diaphragmatic surface. They show minimum enhancement post contrast.

Pathology

Gross pathology of the lesion after resection with the histopathological report.

Case Discussion

This patient has a history of multiple surgeries due to recurrence right submandibular gland pleomorphic adenoma. The expansile lytic lesion in the mandible was present 7 years previously but becomes symptomatic in the last four years.

With the possibility of metastatic disease, a chest x-ray was arranged, which demonstrated a nodule and on the subsequent CT two nodules were seen. 

The patient underwent resection of the lytic lesion in the mandible and bone graft. The specimen sent for histopathology which was proven to be metastatic deposits of pleomorphic adenoma but with benign histology 

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Case information

rID: 66325
Published: 3rd Mar 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: The Arab Board Of Health Specializations

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